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Related Experiment Video

Updated: Feb 17, 2026

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Validation of Foot Angular Measurements Using Intraoperative Simulated Weightbearing Fluoroscopic Images.

Troye J Joseph1, Nikiforos P Saragas1,2, Michael de Buys1,2

  • 1Division of Orthopaedic Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witswatersrand, Parktown, Johannesburg, South Africa.

Foot & Ankle Orthopaedics
|February 16, 2026
PubMed
Summary

Intraoperative simulated weightbearing fluoroscopy accurately measures foot alignment, correlating well with standard radiographs. This technique may improve accuracy in foot deformity correction surgery.

Keywords:
foot angular measurementsfoot deformity correctionintraoperative fluoroscopysimulated weightbearing imagingweightbearing radiographs

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Area of Science:

  • Orthopedic surgery
  • Medical imaging

Background:

  • Weightbearing foot and ankle radiographs are crucial for assessing skeletal geometry under load.
  • Radiographic measurements guide surgical decisions and have been validated using weightbearing images.
  • Intraoperative simulation of weightbearing could enhance the accuracy of foot and ankle deformity correction.

Purpose of the Study:

  • To validate the accuracy of angular measurements on intraoperative simulated weightbearing fluoroscopic foot images.
  • To compare intraoperative simulated weightbearing fluoroscopic measurements with standard preoperative weightbearing radiographs.

Main Methods:

  • A prospective study involving 50 patients undergoing elective foot surgery.
  • Intraoperative simulated weightbearing was performed, yielding anteroposterior and lateral fluoroscopic images.
  • Six angular measurements were taken on both preoperative weightbearing radiographs and intraoperative fluoroscopic images by four researchers at two intervals.

Main Results:

  • The hallux valgus angle (HVA), interphalangeal angle (IPA), 4-5 intermetatarsal angle (4-5 IMA), and talocalcaneal angle (TCA) showed no statistically significant mean difference between the two imaging methods.
  • The intermetatarsal angle (IMA) and calcaneal pitch (CP) exhibited statistically significant mean differences, but these were deemed clinically negligible.
  • Inter- and intraobserver reliability for all measurements was good to excellent, with strong correlations found for HVA, IMA, 4-5 IMA, and CP.

Conclusions:

  • Intraoperative simulated weightbearing fluoroscopic imaging correlates well with standard preoperative weightbearing foot radiographs.
  • This technique offers a potential for more accurate, real-time assessment of alignment during foot deformity correction surgery.